HomeMy WebLinkAboutHomestead_Dillon (10) k7 , CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
Y STANDARD / SUPPLEMENTAL DEDUCTION FORM
• J'I State Form 5473(R19/1-23) HC10
y '" - Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE: Telephone, Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) . ,/y - certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, (date of signature).I(We):
Own. ❑Am(are)buying under recorded contract.
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Count Towns pin Lf Taxin 'strict,(city,town, nship)
a-D'rC-
Qi6 j I l
Parcel Number Q�{�Legal Description Is the property in question:
c '1 ./U /03`0t•& -5 o Real Pro Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that stru is se to pro i om describe the use an. •rtion
of the property utilized to produce income. 11
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JUL 21 2023 X*
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PROPERTY OWNED ELSEWHERE BY CLAMANT
State,County,and Township Is Claimant Vacating Homestead?
❑Yes No
Signatur of Claimant
I hereby certify the above statements are true,correct,and complete. Se 'C1
--ZZ/J .r
Address of.Contact(number and street,city,state,and ZIP pde) ,y Address of Vacated Homestead,if any(number and street,city,state,and ZIP code)
1 ' Q' .48V/ . ce&/-� 1/.41
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) /
11010